Krochmal v. Paul Revere Life Ins. Co.

684 N.W.2d 375
CourtMichigan Court of Appeals
DecidedJuly 21, 2004
Docket242776
StatusPublished
Cited by1 cases

This text of 684 N.W.2d 375 (Krochmal v. Paul Revere Life Ins. Co.) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Krochmal v. Paul Revere Life Ins. Co., 684 N.W.2d 375 (Mich. Ct. App. 2004).

Opinion

684 N.W.2d 375 (2004)
262 Mich.App. 115

Ralph KROCHMAL, Plaintiff-Appellee,
v.
PAUL REVERE LIFE INSURANCE COMPANY, Defendant-Appellant.

Docket No. 242776.

Court of Appeals of Michigan.

Submitted January 21, 2004, at Detroit.
Decided May 20, 2004, at 9:00 a.m.
Released for Publication July 21, 2004.

*376 Grant, Busch & Kirschneri (by David B. Grant), Southfield, for the plaintiff.

Dickinson Wright PLLC (by K. Scott Hamilton), Detroit, for the defendant.

Before: FORT HOOD, P.J., and BANDSTRA and METER, JJ.

METER, J.

Defendant appeals as of right, challenging the trial court's order overruling defendant's claims representative's decision to discontinue disability benefits to plaintiff and ordering the reinstatement of monthly benefits. We agree with the trial court that the disability policy at issue is not governed by the Employee Retirement Income Security Act (ERISA), 29 USC 1001 et seq. Moreover, although we believe that the "arbitrary and capricious" standard of review should have applied to *377 the evaluation of the claims representative's decision, we are bound to follow a decision of this Court mandating a de novo standard of review under the circumstances. Therefore, we affirm.

I. Facts

In 1968, plaintiff and a friend, Kent Seidman, began a vending machine supply company while they were students at Eastern Michigan University; they formed a corporation, originally known as Manimark Company, in 1970. After Seidman died in 1981, plaintiff continued the business by himself as president and chief executive officer. In 1981, plaintiff formed two corporations, Manimark Corporation and Manimark Associates. Manimark Corporation was formed to handle the general vending machine business activities, while Manimark Associates was created as a real estate holding company.

On March 20, 1987, defendant issued a disability policy to plaintiff. Plaintiff testified:

I believe that I purchased the Paul Revere policy personally on my own behalf, not as any kind of company benefit, but as a personal purchase. It was Manimark Corporation [that] received the bill and paid the premium because of the huge amount of premium it was.
in order for me to pay that check or that bill personally, I would have had to take approximately 40 percent more out of the company in order to net down to the premium that Paul Revere wanted. So it was easier for me to have the company pay the bill and make a[n] end of the year tax adjustment on my taxes.

According to plaintiff, his employer, Manimark Corporation, paid one hundred percent of the premiums for defendant's policy using checks drawn on the corporation's bank account.

Plaintiff also testified:

[I]t's as though I paid [the premium] myself with my own personal funds. The corporate account was almost, not quite, but almost an extension of my checking — my personal checking account. It was my company. I owned all of it. I could do anything I want[ed] with it. If I wanted to buy something out of the corporation, I'd buy something out of the corporation. I also did that with life insurance for me. I mean, I don't know how else to explain it. I just took money. It was a salary. It was my money. The corporate money is my money. It was my money. It wasn't anybody else's. It was my money.

Plaintiff acknowledged that he did not reimburse Manimark Corporation for those payments. In addition, plaintiff stated on his application for the policy that his occupation was "President — CEO" and that Manimark Corporation was his "employer."

In the late 1980s, a steel hauler's union sought to unionize plaintiff's company, and plaintiff successfully resisted the unionization. However, a second attempt at unionization in 1990 proved successful. The initial contact by the union bargaining agent was apparently unannounced. According to plaintiff, the agent came into his office, sat down in a chair, and placed a handgun on the table. Plaintiff claimed that the unionization of his company and the trauma of the contact with the union bargaining agent caused him to become agitated and anxious. He testified that about six months before he sold the business in 1996, he began to suffer chest pains, became despondent and anxious, and thought that he was going to have a heart attack.

Plaintiff filed an application for disability benefits under defendant's policy on May 4, 1996, alleging that he was completely *378 unable to perform his occupational duties because of depression and "post-traumatic stress disorder," which plaintiff claimed were caused by the incident with the union official in 1990. In his claim, plaintiff indicated that the policy was not an employer-sponsored policy. After defendant conducted an initial investigation and plaintiff submitted medical documentation in support of his claim, defendant paid benefits to plaintiff monthly for three years, beginning in 1996. In its initial investigation, defendant concluded that the policy was purchased individually and thus was not subject to ERISA.

Later, defendant[1] had plaintiff examined by a psychiatrist who opined that plaintiff was not "so depressed that he cannot work ." Plaintiff's original physician disagreed. Following a final review of all the medical information, defendant denied plaintiff's claim, concluding, on the basis of the medical evidence, that plaintiff did not have a disabling condition. Defendant subsequently discontinued the monthly disability payments to plaintiff.

Plaintiff filed a complaint in the Wayne Circuit Court on February 11, 2000, alleging breach of contract, bad faith, and egregious conduct based on defendant's termination of his monthly benefits under the policy. Although defendant did not seek to remove the action to federal court by asserting that plaintiff's claims were preempted by ERISA, the trial court requested, as a preliminary matter, that the parties address (1) whether the policy was governed by ERISA and (2) the appropriate standard of review to be applied in evaluating the decision of defendant's claims representative to discontinue monthly benefits. The trial court subsequently ruled that the policy did not fall within the scope of ERISA and that "de novo" was the correct standard of review to be employed in evaluating the decision of defendant's claims representative. The court then found "in favor of the plaintiff finding that they [sic] have borne their burden of proof to show that Mr. Krochmal is entitled to benefits from Paul Revere under the terms of [the] policy, and that this Court will overrule the decision of the Paul Revere adjuster finding Mr. Krochmal should be discontinued from benefits."

II. Policy Not Governed by ERISA

Defendant argues that the trial court erred in determining that defendant's policy was not governed by ERISA. Defendant claims that ERISA governs because plaintiff's employer established or maintained the policy. We disagree.

Whether the disability policy in question is part of an employee welfare benefit plan governed by ERISA involves a certain amount of statutory interpretation. We review issues of statutory interpretation de novo. Cruz v. State Farm Mut. Automobile Ins. Co., 466 Mich. 588, 594, 648 N.W.2d 591 (2002).

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684 N.W.2d 375, Counsel Stack Legal Research, https://law.counselstack.com/opinion/krochmal-v-paul-revere-life-ins-co-michctapp-2004.